Is disease a tax that we force the poor to pay?

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Is disease a tax that we force the poor to pay?

That's the provocative question that underlies a report released Thursday by the World Health Organization: Working to overcome the global impact of neglected tropical diseases.

What's a "neglected tropical disease," or NTD for short? In the WHO's definition, there are 17; they are bacterial, viral and parasitic, and include dengue, rabies, trachoma, leprosy, Chagas, sleeping sickness, leishmaniasis, river blindness and Guinea worm. They not only have different causes, they affect different organs of the body and even occur in different climate zones. But in a hard-hitting speech delivered Thursday in Geneva, WHO director Dr. Margaret Chan underlined what links them all: They are diseases of the devastatingly poor, those who exist on $2 or less per day, and thus until now have largely been ignored. Chan said:

What brings these diseases together is our collective failure as an international community to do a better job of reducing poverty and addressing the diseases that are bred by poverty.The neglected tropical diseases form a group because of one shared feature: all occur almost exclusively among very poor people living in tropical parts of the world. All thrive in impoverished settings, where housing is often substandard, safe water and sanitation are scarce, environments are filthy, and insects and other vectors are abundant.Together, these diseases blind, maim, disfigure, disable, and otherwise impair the lives of an estimated 1.2 billion people. Less visibly, they damage internal organs, cause anaemia, retard the growth of children, impair cognitive development, and compromise pregnancy outcomes.The significant damage to health is frequently compounded by the misery of stigma and social exclusion, especially for women and girls. In many societies, this is a fate worse than death.

With characteristic bluntness, Chan cast these diseases not as an ecological inevitability but as a failure of social justice:

The disease burden has been easy to ignore, as it affects people with little political voice and low visibility on national and international agendas. The immense suffering caused by these diseases is often endured in silence, accepted as an inevitable consequence of being poor.These diseases anchor large numbers of people in poverty. This is poverty passed from one generation to the next in a painful chain of illness, misery, blunted capacity, and lost productivity.

Unlike some of the other diseases I've talked about here, the NTDs mostly don't travel — so they haven't been a concern for the richer industrialized nations of the temperate zones. And as a result, they have often been neglected by research — not only by pharma companies, but by companies developing diagnostic tools and insect-control technologies as well.

But here's the interesting bit. In the developing world, the charge is often leveled that Western-inspired health campaigns are disease-specific and do nothing to improve a country's health overall. (I cannot count the number of times people in India and elsewhere have told me this about polio. The basis of their perception, and whether they are right — which are two separate things — are discussions for another day.) But the WHO contends that addressing NTDs would strengthen health systems in the countries most bedeviled by them, because tackling them would require training new health workers and developing health information systems — and both of those, to be accomplished, will require political will and support.

The strength of the WHO announcement today was that it came bundled with evidence that NTDs are already being addressed successfully, by a combination of government, charity and pharmaco efforts. Guinea worm is on the verge of eradication, and that has been accomplished not by deployment of a drug, but by training people to behave differently around the drinking-water sources where the parasite lurks. The helminth diseases are being addressed collectively by a preventive drug-treatment program that the agency said reached 670 million in 2008.

"For the first time, we have a head start on these ancient companions of poverty," Chan said. "For the first time, more than 1 billion people left behind by socioeconomic progress have a chance to catch up."